CC: Abdominal pain. HPI .
Past Medical Hx:
Family and Social Hx:
VITALS: BP 115/80, T 38.0, R 16, HR 95
GEN: Appears to be in moderate distress secondary to pain.
HEENT: Normocephalic, atraumatic (NCAT), pupils equal, round and reactive (PERRL) and extraocular movements intact (EOMI). Moist mucous membranes. Oropharynx clear and patent, no erythema.
CV, RESP: Regular rate and rhythm, no murmurs, rubs or gallops. Breath sounds are clear to auscultation bilaterally (CTAB), no crackles or ronchi, and symmetrical chest rise, though breathing is noticeably shallow.
ABDOMINAL: Soft, mildly distended abdomen, voluntary guarding no rebound tenderness. Abdominal tenderness on exam is out of proportion to the patient’s level of discomfort. Negative Murphy’s sign.
RECTAL: DRE is negative for gross and occult blood. Perianal area is intact without lesions.
NEURO: Alert, awake and oriented to person, place and time. (AAOx3). CN II-VII intact. Strength 5/5 and sensation intact over all extremities.
Grey-Turner’s Sign: ecchymotic discoloration in the flank.
Cullen’s Sign: ecchymotic discoloration in the periumbilical region.
These signs occur in 1% of cases and reflect intraabdominal hemorrhage and are associated with poor prognosis.
Jaundice is seen in cases of pancreatitis where inflammation is secondary to choledocholithiasis or edema at the head of the pancreas from obstruction of the common bile duct.
Epigastric mass may be palpable due to pseudocyst formation.
Subcutaneous nodular fat necrosis, thrombophlebitis in the legs and polyarthritis are also less commonly seen.
LOCALIZED ILEUS WITH SENTINAL
Non-Contrast CT with peripancreatic fat stranding.
Acute pancreatitis morphology ranges from mild inflammation and edema to severe extensive necrosis and hemorrhage. Findings include:
Microvascular leakage causing edema
Necrosis of fat by lipolytic enzymes
Proteolytic destruction of pancreatic parenchyma
Destruction of blood vessels and subsequent interstitial hemorrhage